Over the past 15 years there has been increasing national emphasis on the participation of individuals with disabilities in the labor force. This concern was highlighted by the establishment of the Presidential Task Force on Employment of Adults with Disabilities by Executive Order on March 13, 1998. The Task Force has as its mission "to create a coordinated and aggressive policy to bring adults with disabilities into gainful employment at a rate that is as close as possible to that of the general adult population." A variety of recent legislation and policy changes address employment opportunities. The Workforce Investment Act of 1998 was implemented with a broad goal of consolidating, coordinating, and improving all national workforce development initiatives, including vocational rehabilitation and youth employment programs. The Americans with Disabilities Act, the Ticket to Work and Work Incentives Improvement Act of 1999, amendments to the Vocational Rehabilitation Act, and changes to Medicaid regulations are all intended to expand access to employment for individuals with disabilities.

Despite these and other policy initiatives on both the state and federal level, employment trends continue to carry both good news and bad news for individuals with significant disabilities. The introduction of supported employment into the Rehabilitation Act in 1986 spurred a dramatic increase in the number of individuals with significant disabilities in integrated employment. In FY99 an estimated 107,000 individuals were supported in integrated employment by state MR/DD agencies, and 28,371 individuals with developmental disabilities were closed into competitive employment by state vocational rehabilitation agencies (including 12,246 closed with supported employment services). The state systems change projects funded by the Rehabilitation Act also resulted in a broad emphasis on change at both state policy and organizational levels. There are many individual examples of organizations that have been successful in closing a sheltered workshop and substantially shifting organizational resources into supports for community employment (Beare, Severson, Lynch, & Schneider, 1992; Block, 1993; Butterworth, Fesko, & Ma, 2000; Murphy & Rogan, 1995; West, Revell, & Wehman, 1998). In FY99 five state MR/DD agencies (Connecticut, Minnesota, New Hampshire, South Dakota, and Washington) reported that over 50% of their participants in day and employment services were in integrated employment (ICI, 2001), suggesting that substantial systems change is occurring in some states.

Along with the significant growth in integrated employment, data show continuing growth in the number of individuals supported in facility-based and non-work services. The total number of individuals supported by state MR/DD agencies in facility-based and non-work services increased in real numbers during this period from 242,000 in FY88 to an estimated 362,000 in FY99 (ICI, 2001). There is also wide variation from state to state in employment participation. Individual state reports vary from a low of 4% participating in integrated employment to a high of 60% in integrated employment, suggesting that state commitment to employment outcomes is highly variable.

Continuing the expansion of integrated employment opportunities requires a clear understanding of the organizational and systems factors that influence change and expand access to integrated employment. This monograph will focus on change at an organizational level in four organizations that were engaged in a change process during 1998 and 1999. This work represents the second phase of a study of ten community rehabilitation providers, including six that successfully closed a facility-based program in the period between 1989 and 1994. The first six organizations are profiled in Volumes I and II of this series (Butterworth, Fesko, & Ma, 1999; Fesko & Butterworth, 1999). The project was designed to answer three primary research questions:

What are the motivators and barriers that have influenced programs--
decisions to convert resources from facility-based services to community
employment?

How did each organization approach the planning, communication, and implementation of the change process?

What obstacles have organizations experienced and how have they
responded to these obstacles to maintain the change process? What
strategies and variables have had a positive impact on maintaining
organizational change efforts?

This chapter presents a summary of the research, the experiences of four organizations that are in the process of expanding their integrated employment services, and a comparison of these organizations with the six original organizations that closed a facility-based program.

The subsequent chapters in this monograph provide detailed case studies of the four organizations at two points in time; an initial comprehensive site visit and a follow-up site visit approximately one year later to assess progress and changes in the organization's plans. For a more detailed description of the six original case studies please refer to Conversion to Integrated Employment: Case Studies of Organizational Change (Volumes I and II), and to Butterworth and Fesko (2000).

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